HomeMy WebLinkAbout12-27-05
Estate of ELAINE E. SCHELLER
also known as
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
al-D5...11DC1
No.
To:
Deceased.
Register of Wills for the
County of CUMBERLAND in the
Commonwealth of Pennsylvania
Social Security No. 185-26-6242
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appliES
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decedent was domiciled at death in LOWER ALLEN TWP. CUMBERLAN County, Pennsylvania, with
h ER last family or principal residence at 1 BOXWOOD LANE. CAMP HILL. PA 17011
(list street, number, Twp. or Boro.)
Decedent, then 69 years of age, died 11/30/2005
at 4905 E. TRINDLE RD.. HAMPDEN TWP.. CUMBERLAND COUNTY PA
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
1 BOXWOOD LANE, CAMP HILL, PA 17011
$
$
$
$
75 000.00
0.00
0.00
100.000.00
Petitioner after a proper search ha~ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
222 CREEK RIDGE CHASE
LINDA M. BARBUSH DAUGHTER ALPHARETTA GA 30004
1721 HARMONY DRIVE
DIANE SCHELLER DAUGHTER CLEARWATER FL 33756
1 BOXWOOD LANE
MARK SCHELLER SON CAMP HILL PA 17011
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THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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LINDA M. BARBUSH
222 CREEK RIDGE CHASE
ALPHARETT A GA 30004
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYL VANIA }
ss
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief ofpetitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
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No. dt'O~'-I/D4
Estate of ELAINE E. SCHELLER
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
Hb. q'f\ 7-00~
AND NOW , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that ,XI.'lC<c;J fY1 131- /}, tI J L-
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
/Jf;I "i I^- rn 13 tL '/buS L
are hereby granted to
$J~fr
~%vD
J CPt fhIm $ IS. 6 I)
. TOTAL _ $ .'3C)(;1
Filed .hler., J.7 .,' .).D,I).'5. A.D.
FEES
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~~n Cl'PL.d?u ALL ,,' / FV/6.)J/,/,L/
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ATTORNEY (Sup. Ct. I.D. No.)
in the estate of ELAINE E. SCHELLER
Letters of Administration. . .
Short Certificates (" ). . . . . .
Renunciation. . . .~ . . . . . . .
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IJ ADDRESS
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. ~( i -f?tt. ? C( ..h
PHONE
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This is to certify that the information here given is correctly copied trom an onglllal certificate ot deatli ouly Ided with me as
Local Registrar~ The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
j 1 ~;i 3
No.
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Local Registrar
Fee for this certificate. 56.00
DEe 0 2 2005
Date
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C_.~
en
143 Rev. 2JB7
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
-'-~
STATE FILE NUMBER
NAME OF DECEDENT (Firsl Middle, Last)
1. Elaine
AGE (Last Birthday)
E.
Scheller
SEX SOCIAL SECURITY NUMBER
fEMALE 3.185 26 - 6242
PLACE OF EA TH Che ani one. instruction
HOSPIT"L
(npatient M ER/Outpl~ienl 0
7. Ba.
FACIUTY NAME (It not institution, g\'Je street and numlJer)
DATE OF DEATH (Monlh, Day. Year)
~ovember 30, 2005
BIRTHPLACE (City and
State or Foreign Country)
DOAD
Re:sidence 0 ~\~~fy) 0
RACE. American Indian, Black, White, at .
(Specify)
10. White
SURVIVING SPOUSE
(If wiffl, give maiden name)
8b. Cumberland
DECEDENT'S USUAL OCCUPATION
(GJv::,Q~~:re~~o d~te\J~nf~~~r
8c.Sampden Twp.
KIND OF BUSINESS IINDUSTRV
AS DECEDENT EVER IN
U.S, ARI.I.ED FORCES?
Ves 0 Nn ~ 12 (0-12)
12. 13. '
17.. SIale Pennsylvania
MARITAL STATUS - Manied,
Never Married, Widowed,
Divorced (Specify)
14. Widowed
- 11a. Claims Ad"ustor 11b.Heal<.::h Insurance
DECEDENT'S MAILING ADDRESS (Slreel. CitylTown, SIal., Zip Code) DECEDENT'S
1 Boxwood LaEe ~~~~iNCE
Camp Hill, PA 17011 ~~e~t~~~":~~lln$
Cumbe:::-land
1 Tb. Count'J
Did
decodent
live in a
to'.\Itiship?
17c. a. Yes, decedent lived In
17d. 0 ~~h~e~~~?~j~j;: of
Lower
Township
twp.
16.
FATHER'S NAME (First. Middle, Last)
18. Frede ric k W . Jessen
INFORMANT'S NAME rTYm'IPrin))
20a. Linda M. ~art)Ush
METHOD OF DiSPOSITiON
Donation 0 Burial l:iI Cremation Gemova\ from St.ate D
. 21a. Other (Specify) D 21J:>ecember 3,
. SIGNA TU N L SE ICE LICENSEE OR PERSON ACTING AS SUCH
- 22a.
Com ete ite 3a-c only when certifying
~;;ii physician Is not available at time ot death to
.:,~ certify cause of death.
:: Items 24-26 must be completed by
~ person who pronounces death,
=-
citylboro.
MOTHER'S ,~AME (First, Middle, Maiden Surname)
19. Hilda Kerver
iNFORMANT'S MAILING ADDRESS (Street. CityfTown, State. Zip Code)
20
2005
L1c'~"t)'r!R849 L
22b.
Paxton Twp.
To the best of my knowledge, death occurred at the time, date and place stated
(Signature and Title)
23..
TIME OF DEATH
IMMEDIATE CAUSE (Final
disease or condition
'i r.sulting in death)-
':Sequentially list conditions b
::lit any, leading 10 immediate
;J cause. Enter UNDERLYING
... CAUSE (Disease or injury [ c
..that initiated events
~resultjng on death) LAST d.
i; WAS AN AUTOPSY WERE AUTOPSV FiNDINGS
-! PERFORMED? AVAILABLE PRIOR TO
~ g~~~~~~~N OF CAUSE
a.
M ~f-if\....J -tr-. flL
DUE TO (OR AS A CONSEQUENCE OF)
~-€.chJ
{' (}-Vl ( f y
23b. 23c.
WAS CASE REFERRED TO A MEDICAL EXAMINER (CORONER?
26. Ves D No Jell
: Approximate PART II: Other significant conditions contributing lo death. but
'inteNal between not resulting in the underlying cause given in PART I.
: onset and death
: [,5-
24.
DATE PRONOUNCED DEAD (Monlh. Day, Year)
I /~ 30 -oS-
25.
27. PART I: Enler the dl....u, Injurie. or camplh;.atlona whlc:h clused the death. Do nal enter the mode of dying. .uch u cardiae or resplralory arrut. shoc-It. or Martfallura.
U.t only one CilUU on each IIn..
DUE TO (OR AS A CONSEQUENCE OF)'
DUE TO (OR AS A CONSEQUENCE OF)
VesD
MANNER OF DEATH
g
o
D
TIME OF INJURV
iNJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
Natl'ral
Homicide
'.
~ Ves D No rJ
Accldt:rH
Pending Investigation
NoD
Suicide
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'2-22-05; 12:56PM;STONE LAFAVER SHE~
;717 774 6143
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RENUNCIATION
Estate of ELAINE E. SCHELLER
No.
a 1/ D ") -I} 0 (1
also known as
, Deceased
The undersigned,DIANE L. SCHELLER, DAUGHTER
(Relationship)
of
(Capacity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters OF ADMINISTRATION be issued to LINDA M. BARBUSH
Witness '\)lc~r-...Q.. L.~x.4.\~:~"&md this J.-r").. ~ day of
t:JL ~.
DIANE L. SCHELLER
1721 HARMONY DRIVE, CLEARWATER
(Address)
FL 33756
(Signature)
(Address)
(Signature)
(Address)
Sworn to or affirmed and subscribed
before me thisJ."J.. T'l) day of 4.Pr~~
Dl!t"........~
:200 <,
:.....,c,. .........11......
. \\ ANGELA'M:'MEOLOCK'..!
i /i.p '71;.:;sion # 000160931 :
: ~~~. .
: -",loFF. ".' ,:. .::rcs 10/27/2006 i
: "/1/11'"'' uonded through :
;t~;~:~~~~)...~!?~~~ Notary Assn.. Inc. !
. .................. ,.....
o
Notary Public
My Commission Expires: It) -'l,-'blp
(Signature and seal of Notary or other
official qualified to administer oaths. Show
date of expiration of Notary's commission.)
NOTE: Renunciations executed outside the Office of Register of Wills are
required in some counties to be notarized.
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12/22/05 THU 14:03 [TX/RX NO 6334]
Register ofWiHs of Cumberland County
RENUNCIATION
Estate of E~rl;( r< E'
Also known as
c
<;; ~H ~ ... \... ~. "
No.
,,1- 0) ~ 1107
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned ;f;1-1/{ '" 41 Se. fa-<- <-is" :; Cry
(Name) (Rela'tionship) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters
be issued to
71tJJ:
Witness my/our hand(s) this L.. i day of
Pc'- Ch l:>~ ..~
, 20-EJ:
Affirmed and subscribed before me this
day of
(Signature)
(Address)
Notary Public
My Commission Expires:
(Signature)
: '\.)
--....:
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Or
Affirmed and subscribed before me this
ii!i.dayof ~ ,
)j) J/ltJdc, Ht1ic.q 6fnl ~ v
Reg;,'e'?f 'i~ "'Il1 $ f
puty rv
/ di~)
1 (Si(nature)
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(Address)
Signature and seal of Notary or other official
ualified to administer oaths. Show date of
~piration of Notary's commission}